Lanthanum (Fosrenol) tablets for adults with chronic kidney disease who are on dialysis

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Lanthanum (Fosrenol) was listed on the Pharmaceutical Benefits Scheme on 1 May 2009. The authority listing allows prescribing for the treatment of hyperphosphataemia in adults with chronic kidney disease who are on dialysis*, but not in combination with sevelamer.1 Until this listing, lanthanum had been available only on private prescription.

Lanthanum is a rare earth element that reduces serum phosphate concentration by binding phosphate in the gut.2,3 Calcium-based phosphate binders are first line for the treatment of hyperphosphataemia (unless serum calcium concentration is > 2.4 mmol/L).4 Lanthanum may be an alternative for people taking calcium carbonate (Caltrate, Cal-Sup), for whom hypercalcaemia is a problem.2,4 Other available phosphate binders include aluminium hydroxide (Alu-tab), which is not PBS listed, and sevelamer (Renagel), which has the same PBS authority listing as lanthanum.5

Monitor serum phosphate concentrations every 2–3 weeks (adjust lanthanum dose as needed) until stable, then at regular intervals.2,3 Although only a very small amount is absorbed, it is distributed into bone.3 Lanthanum often causes gastrointestinal adverse effects (e.g. nausea). As with any new drug, the full toxicity profile and long-term effects of lanthanum are unknown.

A 6-month unblinded randomised trial (n = 777) showed similar efficacy for lanthanum and calcium carbonate in reducing serum phosphate concentrations.6 This was maintained for those who remained in the extension trial: 46 people for 2.5 years7 and 22 people for 6 years.8 Another randomised unblinded trial (2 years, n = 1359) showed similar efficacy for lanthanum and other phosphate binders (including calcium [carbonate and acetate] and sevelamer).9

*Hyperphosphataemia in an adult with chronic kidney disease who is on dialysis and whose serum phosphate level is not controlled with other products and when:
(a) serum phosphate concentration is > 1.6 mmol/L, or
(b) the serum calcium (mmol/L) × phosphate (mmol/L) product is > 4.0 mmol2/L2

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